Dual Diagnosis

Cannabis has been used in medicine for thousands of years for various medical conditions. Over the last decade it is increasingly

getting used in the treatment of chronic pain. Cannabis has been shown to have some positive effi cacy in the reduction of pain as

an adjunct in therapy combined with opioids. Clinical studies published are mostly small in number and solely for neuropathic pain.

Most studies that showed a clinical benefi t were short in duration. Longer-term studies for more than 4 weeks have reported psychosis

in the patients with percentages ranging from 36.3% to even 80%. Most patients report a long list of side eff ects associated with the use

of cannabis. Symptoms reported are memory problems, problems with motor coordination and impaired judgment and more serious

medical problems like cancer or cardiac ischemia. Cannabis consists of more than 60 pharmacologically active cannabinoids. Th e

primary cannabinoids in marijuana are delta9-tetrahydrocannabinol (THC) and cannabidiol. Not all cannabinoids are yet identifi ed

or understood. Th e dosing of cannabis and its metabolism are problematic in the treatment as well. Cannabis is liposoluble and

tends to accumulate in adipose tissue together with its derivates. Th erefore the substance gets released into the body long aft er last

ingestion, resulting in even more potent eff ects and adverse eff ects in the users. Cannabis is a Schedule I substance and the attempt to

discontinue does create a set of symptoms called “marijuana abstinence syndrome”. Symptoms of marijuana withdrawal are consistent

of: anxiety, depression, decreased appetite, headaches, insomnia, irritability, muscle tension, nausea, nightmares and unpleasant vivid

dreams. Lastly, patients develop tolerance to cannabis as well, similar to alcohol, meaning over time are larger doses required to

achieve the same clinical response.